Dynamic imaging of pelvic floor with transperineal sonography.
Explore the source record for details and available documents.
Gastrointestinal Diseases↗
Biomedical subjects
J J O'Connor
Publications and source records attributed to J J O'Connor.
Mechanical integrity of compression-moulded ultra-high molecular weight polyethylene: effects of varying process conditions.
Ultra-high molecular weight polyethylene (UHMWPE) bearing surfaces in knee and hip prostheses are frequently manufactured by direct compression moulding of the as-polymerised powder. A study was made of the important role of the temperature-time sequence in the melt state during processing, in determining the mechanical integrity of mouldings at 37 degrees C. Structural features were determined by calorimetry (for the degree of crystallinity), infra-red spectroscopy (for the degree of oxidation), density measurement, and scanning electron microscopy. Mechanical integrity was assessed by tensile tests at a constant nominal strain-rate of 10(-3) s(-1), with post-failure microscopic examination. For the whole range of melt temperatures 145-200 degrees C and times 10-90 min, essentially the same stress-strain path was followed, reflecting invariance of the degree of crystallinity. However, there were dramatic changes in elongation-to-break, from ca 10% for some mouldings at 145 degrees C to a mean of 560% at 175 degrees C where, at the 86% confidence level, there was evidence for a peak. The rise was explained by microscopy, that revealed two distinct types of fusion defect, of reducing severity with increasing temperature. Type 1 defects were voids arising from incomplete powder compaction, and persisted up to 165 degrees C. Type 2 defects were regions of enhanced deformability at inter-particle boundaries in apparently fully compacted mouldings, evidenced microscopically by localised relative displacements at particle interfaces, during the plastic deformation at 37 degrees C. They persisted up to 200 degrees C. Type 2 defects may be attributed to the slow self-diffusion of UHMWPE in the melt, leading to incomplete homogenisation. even after compaction is complete. The level of oxidation in the mouldings was small but rose with melt temperature, explaining the fall in elongation-to-break at temperatures higher than 175 degrees C.
Biocompatible Materials↗
In vitro evaluation of the resistance to dislocation of a meniscal-bearing total knee prosthesis between 30 degrees and 90 degrees of knee flexion.
An increased incidence of dislocation is the most important potential disadvantage introduced by the use of meniscal-bearing prostheses. The aim of this in vitro study was to measure the resistance to dislocation of a meniscal-bearing total knee arthroplasty in various circumstances and to establish which anatomic structures contribute to bearing stability. The prosthesis was implanted into cadaver knee specimens mounted in a 6 df rig. Dislocation was provoked by applying anteriorly or posteriorly directed forces (20-100N) to the tibia in the plane of the tibial plateau. Dislocation was defined as any stable displacement of the bearing (relative to the tibia or the femur) that persisted after release of the load applied to provoke it. The specimens were tested in an arc of knee flexion between 30 degrees and 90 degrees, with and without simulated quadriceps loads, with and without abducting and adducting loads, and before and after division of the posterior cruciate ligament and the lateral retinaculum. In the presence of quadriceps load, dislocation could not be provoked. In the absence of quadriceps load, dislocation was not provoked by posteriorly directed force but sometimes was caused by anteriorly directed force. All but 1 of the dislocations were unicompartmental, the lateral compartment proving much less stable than the medial. The tendency toward dislocation increased from 30 degrees to 60 degrees and from 60 degrees to 90 degrees of knee flexion. Adducting moments applied to the knee caused lift-off of the lateral femoral condyle from the bearing and increased the tendency toward dislocation. Abducting moments had the opposite effect. Division of the posterior cruciate ligament had no significant effect. Division of the lateral retinaculum increased the tendency toward dislocation. A femoral component that can be implanted without lateral release is desirable.
Cadaver↗
Colonoscopy without sedation.
Explore the source record for details and available documents.
Colonic Polyps↗
Computer-assisted design of the sagittal shapes of a ligament-compatible total ankle replacement.
The poor results of total ankle replacement have been attributed to the inability of designers to restore adequately the critical mutual function of the ligaments and the articular surfaces. The purpose of this study was to design sagittal shapes of the articular surfaces for a new ankle prosthesis to be compatible with the geometry of the retained ligamentous structures. Several ligament-compatible pairs of articular surfaces were tested using a computerised version of a four-bar linkage model. The kinematics of the ankle when replaced by non-conforming two-component and by fully conforming three-component designs with either flat, concave or convex tibial surfaces were assessed by the model. A ligament-compatible convex-tibia fully-congruent three-component prosthesis showed the best features. The three-component prosthesis allows complete congruence over the entire range of flexion. A convex shape for the tibial arc was preferred because of the better degree of entrapment of the meniscal bearing. A 5 cm convex-tibia arc radius gave 2 mm entrapment together with 9.8 mm of tibial bone cut. Ligament elongation imposed by full congruence of the articular surfaces was less than 0.03% of the original length. The original patterns of joint kinematics and ligament tensioning are closely restored in the joint replaced by the proposed prosthesis.
Ankle Joint↗
Desflurane, compared to halothane, augments phenylephrine-induced contraction in isolated rat aorta smooth muscle.
PURPOSE: The mechanism responsible for the mediation of hypertension in response to increased desflurane levels is unclear. This study compared the effect of desflurane and halothane on phenylephrine (PE)-induced contraction in rat aorta ring and the effect of desflurane in the presence and absence of nitric oxide (NO) synthase activity. METHODS: Endothelium-free rat aorta rings were exposed serially to 10(-7) M, 10(-6) M and 10(-5) M PE alone and subsequently in the presence of 2 MAC desflurane and halothane. Secondly, endothelium-free preparations were exposed to 10(-6) M PE serially in the presence of 0, 1, 2 and 3 MAC desflurane and halothane. Thirdly, using an endothelium-intact preparation, the effect of desflurane on PE-induced contraction was examined, in the presence or absence of NG-nitro-L-arginine (L-NNA), an inhibitor of constitutive and inducible NO synthase. RESULTS: Contraction amplitudes secondary to 10(-6) and 10(-5) M PE in endothelium-free preparations were increased by 74% and 36% respectively (P <0.05) in the presence of 2 MAC desflurane compared to controls. In endothelium-free preparations, contraction amplitudes secondary to 10(-6) M PE were increased in the presence of 1 and 2 MAC desflurane by 32% and 18% respectively (P <0.05) and reduced by 16% in the presence of 3 MAC halothane (P <0.05). In endothelium-intact preparations an expected absolute increase in contraction amplitude occurred in the presence of L-NNA but the desflurane effect was detectable both in the presence and absence of L-NNA. CONCLUSION: Our results suggest that desflurane may have a local vasoconstrictive effect independent of endothelium and NO synthase activity. The mechanism remains to be determined.
Anesthetics, Inhalation↗
Mobility of the subtalar joint in the intact ankle complex.
A previous study by these authors showed that the calcaneus follows a unique path of unresisted coupled motion relative to the tibia during passive flexion and that most of this motion occurred at the ankle level. Subtalar motion in the intact ankle complex was observed only when perturbations from this path were induced by the application of force to the calcaneus. Relative motion of the bones of the ankle complex was tracked by stereophotogrammetry in seven specimens. Anatomical landmarks, reference frames and joint angles were defined by standard techniques. Sequential moments were applied to the calcaneus about the long axis of the tibia. Measured movements at subtalar level demonstrated plantarflexion coupled to supination and internal rotation (inversion) and dorsiflexion coupled to pronation and external rotation (eversion). These movements were resisted and were fully recovered when the external load was removed. Subtalar motion diminished as the ankle approached maximal dorsi- and plantarflexion. Two clearly distinguished mean axes of rotation were observed for inversion and eversion runs. The axes of inversion and eversion of the subtalar complex changed orientation along a preferred and repeatable path. The subtalar joint complex occupied only a single stable position in the unloaded state and with no range of unresisted motion. It is inferred that mobility was possible only by the stretching and lengthening of the ligaments and the indentation of the articular surfaces, requiring the application of loads. The subtalar joint complex behaves like a flexible structure.
Ankle Joint↗
Kinematic analysis of a multi-segment foot model for research and clinical applications: a repeatability analysis.
An unbiased understanding of foot kinematics has been difficult to achieve due to the complexity of foot structure and motion. We have developed a protocol for evaluation of foot kinematics during barefoot walking based on a multi-segment foot model. Stereophotogrammetry was used to measure retroreflective markers on three segments of the foot plus the tibia. Repeatability was evaluated between-trial, between-day and between-tester using two subjects and two testers. Subtle patterns and ranges of motion between segments of the foot were consistently detected. We found that repeatability between different days or different testers is primarily subject to variability of marker placement more than inter-tester variability or skin movement. Differences between inter-segment angle curves primarily represent a shift in the absolute value of joint angles from one set of trials to another. In the hallux, variability was greater than desired due to vibration of the marker array used. The method permits objective foot measurement in gait analysis using skin-mounted markers. Quantitative and objective characterisation of the kinematics of the foot during activity is an important area of clinical and research evaluation. With this work we hope to have provided a firm basis for a common protocol for in vivo foot study.
Biomechanical Phenomena↗
Why incongruous knee replacements do not fail early.
Rapid failure of knee prostheses does not usually occur, despite the non-conforming nature of the articulation between femoral and tibial components and the associated large contact pressures. This theoretical study examines the likelihood of fatigue fracture of a layered elastic model loaded by a sliding cylindrical indenter. Cracks (line-defects) were assumed to have nucleated within the layer. The stress intensity factors (SIFs) associated with these cracks were calculated. The values obtained for the SIFs are quite low, with a corresponding low likelihood of crack-growth. When taken in conjunction with the experimentally derived fatigue laws of previous investigators, they suggest that short line-cracks should not grow. It seems that early failures have not simply been due to large shear stresses which occur beneath the prosthesis surface. Other factors, such as the degradation of material through heat-pressing, sterilisation or oxidation, or the deleterious effect of fusion defects, may be required to drive the cracks to delamination.
Humans↗
The pro-inflammatory cytokine interleukin-18 impairs long-term potentiation and NMDA receptor-mediated transmission in the rat hippocampus in vitro.
The effects of the pro-inflammatory cytokine interleukin-18 (IL-18) were investigated on both normal and isolated N-methyl-D-aspartate (NMDA) receptor-mediated field excitatory post synaptic potentials (fEPSP) and on the induction of long-term potentiation (LTP) in the rat dentate gyrus in vitro. Bath perfusion with IL-18 (100 ng/ml) for 20 min prior to high-frequency stimulation had no significant effect on baseline synaptic transmission or paired pulse depression, but did impair the induction of LTP (115.7+/-8.8% versus 150.8+/-8.1% in vehicle control slices, n=6, P<0.05 at 60 min). Further analysis demonstrated that IL-18 significantly depressed the amplitude of pharmacologically isolated NMDA receptor-mediated fEPSP (NMDA-fEPSP; 77.4+/-4.3% of baseline compared to controls at 1 h; P<0.05, n=7), an effect that may underlie the impairment of LTP by IL-18. This action of IL-18 on LTP and NMDA-fEPSPs was attenuated in full by pretreatment of slices with exogenously applied IL-1 receptor antagonist (IL-1ra, 100 ng/ml), the naturally occurring antagonist of IL-1 type 1 receptors. This ability of IL-1ra to block the inhibitory effects of IL-18 is likely to be receptor-specific as no reversal of the tumour necrosis factor-alpha-induced inhibition of LTP was seen with IL-1ra administration (110.7+/-5.4% versus tumour necrosis factor-alpha-treated slices; 107.4+/-8.7%, P=0.6, n=6). These are the first experiments providing evidence of a direct neuromodulatory role for IL-18 in synaptic plasticity.
Animals↗
A comparison between automatically generated linear and parabolic tetrahedra when used to mesh a human femur.
Finite element models of bone segments generated from computed tomography data using automatic mesh generation algorithms are becoming common not only in research but also in clinical applications such as computer aided orthopaedic surgery. Especially in the case of the latter application, the models cannot be verified against an experimental measurement, therefore their inherent accuracy should be well known before drawing conclusions based on the calculated results. This study was carried out to assess the performance of tetrahedral solid finite elements with linear and quadratic displacement functions when they are used to mesh the human femur in conjunction with automatic mesh generator methods. Ten-node quadratic tetrahedra (T10) having parabolic displacement functions were compared with four-node linear tetrahedron elements (T4) on the basis of accuracy and central processing unit (CPU) time. From the analyses of 11 finite element meshes, it was concluded that linear tetrahedral elements should be avoided and quadratic tetrahedral elements ought to be chosen for the purposes of finite element analysis of the human femur. When incremental loading and iterative solution is necessary, the coarsest possible T10 mesh compatible with accuracy is needed to minimize computer capacity and CPU time.
Algorithms↗
SB203580, the p38 mitogen-activated protein kinase inhibitor blocks the inhibitory effect of beta-amyloid on long-term potentiation in the rat hippocampus.
The effect of the beta-amyloid peptide (beta-AP) 25-35 and SB203580, the p38 mitogen-activated protein (MAP) kinase inhibitor, were investigated on long term potentiation (LTP) in the dentate gyrus of the rat hippocampal slice. In the presence of 1 microM beta-AP (25-35) basal synaptic transmission was reduced to 88.9+/-5.2% of control (n=4, P<0.5). Tetanic stimulation of control slices gave rise to a robust LTP (139+/-4%, n=5, P<0.05). 1 microM beta-AP (25-35) was found to inhibit this LTP (104.0+/-4.5% at 90 min; n=4, P<0.05). Perfusion of SB203580 alone (1 microM) had no significant effect on baseline synaptic transmission or LTP (n=4). However, in the presence of SB203580, beta-AP (25-35; 1 microM) did not give rise to a reduction in LTP (150+/-11.8%, n=4). These results suggest that high levels of beta-AP (25-35) may inhibit LTP through a pathway involving the p38 MAP kinase.
Amyloid beta-Peptides↗
The components of passive knee movement are coupled to flexion angle.
Movement of the unloaded knee has been described in several studies by an "envelope of passive flexion", a description that does not describe or explain the widely reported coupling of internal tibial rotation to flexion. The objective of the current study was to show that the envelope of passive knee flexion can be reduced to a coupled path. Two hypotheses were tested: (1) in normal knees flexed passively, internal/external rotation, abduction/adduction and all three components of translation are coupled to flexion angle, and (2) the tibia rotates internally as the knee is flexed passively. Fifteen cadaver knees were flexed in a rig designed to apply minimal resistance to knee movement while three-dimensional kinematics of the femur relative to the tibia were measured with an electromagnetic tracking system. Each specimen displayed internal tibial rotation and posterior, proximal and medial displacement of a reference point with flexion, while a range of ab/adduction behaviour was observed. Mean absolute differences between the flexing and extending paths in normal specimens were under 2 and 0.2 degrees for internal/external tibial rotation and ab/adduction, respectively. Deviation from the movement path was resisted: when released after being displaced, the femur of each normal joint sprang back to its original position on the motion path. It was concluded that passive knee flexion can be described by a coupled path. Although the exact shape of the path is very sensitive to load and varies between knees, knee rotations and translations were always coupled to flexion, and internal tibial rotation with flexion was always observed.
Cadaver↗
A mathematical model of forces in the knee under isometric quadriceps contractions.
OBJECTIVE: To predict the knee's response to isometric quadriceps contractions against a fixed tibial restraint.Design. Mathematical modelling of the human knee joint. BACKGROUND: Isometric quadriceps contraction is commonly used for leg muscle strengthening following ligament injury or reconstruction. It is desirable to know the ligament forces induced but direct measurement is difficult. METHODS: The model, previously applied to the Lachmann or 'drawer' tests, combines an extensible fibre-array representation of the cruciate ligaments with a compressible 'thin-layer' representation of the cartilage. The model allows the knee configuration and force system to be calculated, given flexion angle, restraint position and loading. RESULTS: Inclusion of cartilage deformation increases relative tibio-femoral translation and decreases the ligament forces generated. For each restraint position, a range of flexion angles is found in which no ligament force is required, as opposed to a single flexion angle in the case of incompressible cartilage layers. CONCLUSIONS: Knee geometry and ligament elasticity are found to be the most important factors governing the joint's response to isometric quadriceps contractions, but cartilage deformation is found to be more important than in the Lachmann test. RELEVANCE: Estimation of knee ligament forces is important when devising exercise regimes following ligament injury or reconstruction. The finding of a 'neutral zone' of zero ligament force may have implications for rehabilitation of the ligament-injured knee.
Cartilage↗
Cruciate ligament forces in the human knee during rehabilitation exercises.
OBJECTIVE: To determine the cruciate ligament forces occurring during typical rehabilitation exercises.Design. A combination of non-invasive measurements with mathematical modelling of the lower limb.Background. Direct measurement of ligament forces has not yet been successful in vivo in humans. A promising alternative is to calculate the forces mathematically. METHODS: Sixteen subjects performed isometric and isokinetic or squat exercises while the external forces and limb kinematics were measured. Internal forces were calculated using a geometrical model of the lower limb and the "dynamically determinate one-sided constraint" analysis procedure. RESULTS: During isokinetic/isometric extension, peak anterior cruciate ligament forces, occurring at knee angles of 35-40 degrees, may reach 0.55x body-weight. Peak posterior cruciate ligament forces are lower and occur around 90 degrees. During isokinetic/isometric flexion, peak posterior cruciate forces, which occur around 90 degrees, may exceed 4x body-weight; the anterior cruciate is not loaded. During squats, the anterior cruciate is lightly loaded at knee angles up to 50 degrees, after which the posterior cruciate is loaded. Peak posterior cruciate forces occur near the lowest point of the squat and may reach 3.5x body-weight. CONCLUSIONS: For anterior cruciate injuries, squats should be safer than isokinetic or isometric extension for quadriceps strengthening, though isokinetic or isometric flexion may safely be used for hamstrings strengthening. For posterior cruciate injuries, isokinetic extension at knee angles less than 70 degrees should be safe but isokinetic flexion and deep squats should be avoided until healing is well-advanced. RELEVANCE: Good rehabilitation is vital for a successful outcome to cruciate ligament injuries. Knowledge of ligament forces can aid the physician in the design of improved rehabilitation protocols.
Adult↗
The role of the passive structures in the mobility and stability of the human ankle joint: a literature review.
The mobility and stability of the ankle joint have been extensively investigated, but many critical important issues still need to be elucidated. However, there seems to be a general agreement on several important observations. A more isometric pattern of rotation for the calcaneofibular and the tibiocalcaneal ligaments with respect to all the others has been reported. Many recent studies have found changing positions of the instantaneous axis of rotation, suggesting that the hinge joint concept is an oversimplification for the ankle joint. A few recent works have also claimed anterior shift of the contact area at the tibial mortise during dorsiflexion, which would imply combined rolling and sliding motion at this joint. Many findings from the literature support the view of a close interaction between the geometry of the ligaments and the shapes of the articular surfaces in guiding and stabilizing motion at the ankle joint.
Ankle Joint↗
The variation in the orientations and moment arms of the knee extensor and flexor muscle tendons with increasing muscle force: a mathematical analysis.
The orientations and moment arms of the knee extensor and flexor muscle tendons are evaluated with increasing values of muscle force during simulated isometric exercises. A four-bar linkage model of the knee in the sagittal plane was used to define the motion of the joint in the unloaded state during 0-120 degrees flexion. The cruciate and collateral ligaments were represented by arrays of elastic fibres, which were recruited sequentially under load or remained buckled when slack. A bi-articular model of the patello-femoral joint was used. Simple straight-line representation was used for the lines of action of the forces transmitted by the model muscle tendons. The effects of tissue deformation with increasing muscle force were considered. During quadriceps contraction resisted by an external flexing load, the maximum change in moment arm of the patellar tendon was found to be 2 per cent at 0 degree flexion when the quadriceps force was increased tenfold, from 250 to 2500 N. The corresponding maximum change in orientation of the tendon was 3 degrees at 120 degrees flexion. During hamstrings contraction resisted by an external extending load, the maximum change in moment arm of the hamstrings tendon was 8 per cent at 60 degrees flexion when the hamstrings force was increased tenfold, from 100 to 1000 N. During gastrocnemious contraction, the corresponding maximum change for the gastrocnemious tendon was 3 per cent at 0 degree. The orientations of the flexor muscle tendons in this range of force either remained constant or changed by 1 degree or less at any flexion angle. The general trend at any flexion angle was that, as the muscle force was increased, the moment arms and the orientations approached nearly constant values, showing asymptotic behaviour. It is concluded that experimental simulations of knee muscle action with low values of the externally applied load, of the order of 50 N, can provide reliable estimates of the relationships between muscle forces and external loads during activity.
Humans↗